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From Fourth International, Fall 1955, from Tamiment Library microfilm archives
Transcribed & marked up by Andrew Pollack for the Encyclopaedia of Trotskyism On-Line (ETOL).
The public felt cheated, tricked, let down. Nor has the continuous flow of syrupy statements in Washington been able to soothe them. This is not surprising since the Eisenhower administration has yet to explain in forthright manner what went wrong with the Salk vaccine. More than one “all-out campaign to restore public confidence” has been set in motion, but public confidence is not easily restored when the Federal government makes promises one day, breaks them the next, reinstates them the third day, only to break them anew the fourth.
What went wrong and why? Why is the government so reluctant to tell what really happened?
First of all we must understand the character of the National Infantile Paralysis Foundation. This is a private charity organization, the creation of Franklin D. Roosevelt, his pet charity, so to say, which grew out of his personal encounter with polio in 1921 and out of the Georgia Hot Spring Foundation founded by him. in 1927. The Polio Foundation was incorporated in 1938 and has collected funds since then through its so-called “March of Dimes” for the “fight against polio.”
The more publicity the Polio Foundation drums up, the greater the public donations it receives. In this case, the publicity experts of the Foundation bordered on sheer genius. The entire nation waited with baited breath for the report by Dr. Francis Jr. evaluating the 1954 field trials of the Salk vaccine. For days, the press, radio, and television played up the coming report. Case-hardened newspaper reporters noted that the event looked more like a super-colossal Hollywood premiere than anything connected with science.
Outside the hall, where Dr. Francis Jr. was to read his report to the select audience of 500 scientists and physicians, tens of thousands milled about, while television cameras and radio microphones singled out medical bigwigs going into the meeting. In the press room, more than 150 newspaper, radio, and television reporters scrambled for the 300 copies of the Francis report handed them one hour and five minutes before the actual reading. And when Dr. Francis Jr. appeared at the lectern, a battery of 16 television and newsreel cameras went into action.
The same afternoon, Basil O’Connor, president of the National Infantile Paralysis Foundation, announced that nine million children were going to receive free vaccine contracted and paid for by the Foundation.
The theatrical setting of the Francis report could not possibly have had any bearing on the defective vaccine discovered later. But it did make it more difficult for Washington to get off the hook when millions of enraged parents demanded an explanation. The real question involved is not whether the Polio Foundation had overpublicized the report but whether medical research and treatment, in the richest country the world has yet seen, needs to be subsidized by private charity organizations and annual charity drives, a question to which we shall return later.
The Eisenhower administration, certainly, is hardly in position to complain about over-publicity, since it contributed its share to the hullabaloo. Even while Dr. Francis Jr. was talking to his Michigan audience, the administration, through United States Secretary of Health, Education, and Welfare, Mrs. Oveta Culp Hobby, was preparing to rush center-stage and take a deep bow for an achievement in which it had played little or no part.
Mrs. Hobby’s signature licensing the production of the vaccine (as required by the National Biologics Control Act of 1913 for such materials) was to have been what is known in Washington as a “full dress ceremony,” with photographers, television, newsreels, etc. Unfortunately, as Dr. Scheele, Surgeon-General of the United States, explained, “things were running a bit behind schedule in Ann Arbor,” and the ceremony was cancelled.
This minor mishap, however, did not deter our Republican stalwarts. As Mrs. Hobby stated the next day before the Senate Labor and Public Welfare Committee: “The White House is very much aware of this problem and how best to publicize the polio vaccine.” Eisenhower instructed the United States Department of State to give the world full information about the polio vaccine. John Foster Dulles, in turn, stated that he would immediately send copies of the Francis report to American embassies in the 75 nations with which the United States has diplomatic relations.
This act of the Republican administration, too, fell rather short of the mark, since the United States Department of Commerce slapped export controls on the vaccine. (Fortunately for the rest of the world — and unfortunately for us — polio is predominantly a North American affliction, more than one-half of all reported cases occurring in the United States and Canada.)
The Republican administration was not alone in trying to get into the Polio Foundation’s act. No sooner had O’Connor announced the free immunization program than the American Medical Association spoke up. The Polio Foundation had stipulated that physicians dispensing the free vaccine would not be permitted to charge for it. Both the Chicago and the Illinois Medical Societies (Chicago is the home office of the AMA) objected “on principle” to the Foundation’s stipulation. The AMA had an alternate plan: Physicians should charge for injecting the free vaccine. The Polio Foundation refused to budge, and, rather tepidly, the AMA decided to play along, swallowing its “principles.”
By way of compensation, no one opposed its “principles” when it came to the vaccine being sold through regular commercial channels. In chorus, local chapters of the AMA decided that doctors should charge costs: $6 retail for the vaccine, $4.33 wholesale to the doctor, plus an estimated $5 for each of three office visits for the shots.
There are probably at least 100 million people in this country anxious to be immunized against polio. At $15 a head, that equals 1 1/2 billion dollars. Divided among the 100,000 physicians and pediatricians reportedly available for this work, that amounts to $15,000 for each physician! Since the doctor buys the vaccine wholesale at $4.33 and sells it for $6, that means another $1,670 for each physician. We can see that the “principles” of the AMA come at a high price.
In comparison to this, the take of the pharmaceutical concerns manufacturing the vaccine seems almost paltry: 100 million people times $4.33 equals 433 million dollars. However, since annual pharmaceutical sales by all the drug companies in this country total roughly 1 1/2 billion dollars, the increase in the volume of business due to the polio vaccine (433 million dollars, prorated over three to four years) would expand the drug market by 7 to 10%, with the increase being shared by only six companies.
Wall Street greeted the Francis report by making drug shares the most active items on the Stock Exchange. But speculators rushing in for the bonanza found that, actually, they were a little late. Supposedly, no top secret during the war had been more zealously guarded than the Francis report. According to newspaper reports, not even Dr. Salk or Basil O’Connor had read it beforehand. But as Loeb, Rhoades and Co., one of the country’s largest stock brokers, observed in a private newsletter circulated among their clients, “the financial community, with its usual perspicacity and aplomb, knew the findings well in advance” and, we might add, had supplied itself well with investments in the appropriate stocks.
Drew Pearson, in his May 25 column revealed that, following the 1954 field trials of the vaccine, Dr. Salk was unable to interest the drug companies in producing the vaccine. Only after O’Connor of the Polio Foundation laid nine million dollars cash on the barrelhead in orders did some of the drug companies become interested. This bit of information not only proves even to such a staunch free-enterprise supporter as Drew Pearson that the drug companies hardly deserved the juicy plum handed them by Dr. Salk and the Polio Foundation, it also illustrates that O’Connor knew that the vaccine was a success even without reading Dr. Francis’ report and that all the hoopla around the report was strictly publicity.
When confronted with the high cost of the vaccine, quite a few people began to ask embarrassing questions along these lines: The research behind the development of the polio vaccine and the field tests had cost 22 million dollars, all of which had been paid by the Polio Foundation. Every penny of these 22 million dollars thus had come directly from the annual “March of Dimes.” The American people had opened up their hearts and their pocketbooks for the “fight against infantile paralysis.” More than that, in the field trials last year, involving almost two million children, parents had gone further and volunteered their children. People felt that the vaccine was theirs, that it was developed with their money and tested with their children, and that therefore polio shots should be free for everyone. However, as we have seen, the AMA and the drug companies were more concerned with fees and profits than with any “fight against infantile paralysis.”
A typical advertisement in the Los Angeles Times appealing to speculators in drug stocks, points out what a boon the polio vaccine business was going to be to the drug companies, “now that the exaggerated ‘wonder drug’ boom of a few years has worn off.”
As a matter of fact, many of the new “miracle drugs” deserve their success, but it has been clear for some time to responsible medical authorities that neither the antibiotics (such as Penicillin, Streptomycin, or the broad-spectrum antibiotics, such as Terramycin, Aureomycin, or chlorotetracycline) nor the synthetics (such as the sulfa drugs) actually met the real challenge of the virus infections.
As each new “wonder drug” hit the market, sensational cures were reported — until the germs adapted and became resistant. Instead of people becoming immune to the germs, the germs became immune to the cure! Another “wonder drug” would hit the market and the cycle would be repeated. Along that road, there is no end in sight.
The medical profession continues to prescribe “wonder drugs,” more often than not to reassure the patient and to justify the doctor’s fee. It seems a rather expensive variation of the placebo (sugar pill) cure. In a sick human being, the psychological effect of such medical trickery may be of great and sometimes even of paramount importance, of course; but it must be pointed out that the old sugar pill was a lot less expensive than the antibiotics or the antihistamines, some of which retail for 50 cents or $1 a pill.
The drug companies have grown fat and complacent on the “wonder drugs.” As a group, the antibiotics constitute a 260-million-dollar-a-year business: Penicillin alone brings in 130 million dollars a year, Streptomycin 50 million dollars. Among the broad-spectrum antibiotics, Terramycin is patented by Pfizer, while Cyanamid owns Aureomycin, the current big seller being chlorotetracycline which commands a 40-million-dollar-a-year market (at 50 cents a pill, six to 12 pills per prescription, this means that it is prescribed about 1 1/2 million to 3 1/2 million times a year).
The general public has probably never even heard of tetracycline since it is sold as Tetracyn by Pfizer, Polycycline by Bristol-Myers, Achromycin by Lederle, Steclin by Squibb, and Panmycin by Upjohn — all of whom are fighting tooth and nail for patent rights on tetracycline in the courts. As Chemical Week puts it, the 40-million-dollar-a-year tetracycline market is well worth fighting for, as is the 50-million-dollar-a-year cortisone market, which is also in the courts.
In contrast to the haste and profusion with which most drugs are thrown on the market and enter clinical practice, the polio vaccine developed by Dr. Salk was field-tested by means of the largest control tests ever conducted. The polio vaccine field trials of 1954 involved 1,800,000 children and cost 7 1/2 million dollars, paid for by the Polio Foundation. The evaluation report of the trials, by Dr. Francis Jr. and his staff, alone cost $900,000, also paid for by the “March of Dimes” funds.
We have come a long way since 1880, when Louis Pasteur vaccinated one nine-year old boy who had been bitten by a rabid dog, thereby establishing the vaccine in medical practice. Today, it takes almost two million children, teams of investigators, consisting not only of physicians, but of chemists, pharmacologists, nurses, social workers, statisticians, electronic brains, and what not, AND 7 1/2 million dollars to test a vaccine. Yet, contemporary American medical practice is organized and conducted along the same lines as in Pasteur’s day, 75 years ago.
With doctors competing for patients, private medical practice provides no efficient mechanism for rigidly controlled mass tests of new remedies. The “family doctor,” who under the present set-up of fee-for-service medicine forms the backbone of medical practice in this country, can test new remedies on his own patients, if his private practice is large enough, or, if he has a hospital connection, the doctor might test it on the patients there. But mass clinical testing, including the checking of the preparation of the drug, the dose and method of administration, the recording of effects in suitably selected samples of the population, the rigid statistical analysis of results, requires more knowledge, skill, time, effort, and money than the “family physician” can provide. Controlled clinical mass trials thus are an exception rather than the rule in this country today.
The Council of Pharmacy and Chemistry of the AMA is supposed to fill this gap by informing the practising physician about new remedies. Its reports are long-delayed and far between, not to mention the fact that the doctor-businessman in his private practice hardly has the time to keep abreast of the avalanche of medical literature pouring from the presses. The drug companies, in the meantime, exert quite a bit of pressure on the practitioner. Some of it is quite subtle; some just the opposite.
Thus, 54,000 physicians, or almost one-third of all doctors in this country, attended a closed-circuit television showing of the Francis report at 61 private conclaves throughout the country. In New York, the grand ballroom of the Waldorf-Astoria was crowded with upward of 2,000 physicians and their wives. Throughout the country, the showing was sponsored by none other than Eli Lilly, one of the vaccine makers! This technique is known as “low-key” selling in the advertising game.
Thus, Squibb, Pfizer, Winthrop-Stearns ring the cash register with medical movies shown free to the doctors. Lederle Labs specialize in film programs plus day-long medical symposiums, organized in cooperation with local medical societies.
At such shows or symposiums, there is a pamphlet rack containing the company’s literature; company salesmen mingle sociably with the medics at luncheon; a company M.D. at the speaker’s table is introduced; both the printed program and the chairman briefly mention the company’s sponsorship. A special program for the doctors’ wives is provided — a fashion show, tea, a card party, a hair-styling demonstration. There are souvenir mementos, pocket combs, playing cards, all with the company’s name, of course. And then comes the sales call at the doc’s office by the company salesman. At that point, we can be safe in assuming, the sales pressure becomes a little more direct.
Dr. Hildebrand, president of the American Academy of General Practice, addressing the Pharmaceutical Manufacturers Association in June of this year, indicated that one of the main complaints of the practitioner was that the drug-company salesmen were “not always truthful about their products.” As Dr. Hildebrand put it rather delicately: “Business relations and ethics have been under considerable strain as of late and the competitive rush for dollars has caused problems.”
The Federal Food and Drug Administration has a label indicating that the drug showed no initial ill effects on laboratory animals or humans. But this does not mean either that the effects claimed for the drug are fully justified or that the remedy has been adequately tested for all possible toxic or side effects under rigidly controlled clinical experiments. Chloromycetin, for instance, was shown to be a valuable broad-spectrum antibiotic, free from any initial toxic effect on laboratory animals or humans. Not until two years after its registration by the Food and Drug Administration and its introduction into clinical practice was it shown to cause serious blood changes (aplastic anemia) to susceptible persons. Initial and usually exaggerated successes are one thing, mass field or clinical tests quite another.
If the testing of the polio vaccine is compared with that of most other new remedies, it becomes clear that the Francis report was not at all “a premature announcement of a medical discovery insufficiently tested,” as the General Federation of Womens’ Clubs almost said on May 26. Nor is it true that the use of the vaccine was “premature” and that “perhaps we were not justified in ‘rushing’ it into wide use,” as Dr. Price of the AMA inferred June 15 before the Senate Committee on Labor and Public Welfare. Basil O’Connor was much closer to the truth when he asserted before the same group that no remedy “in the history of the world had the preparation, testing, and evaluation that the Salk vaccine did.”
If anyone was “rushing,” it was the drug companies, poised like arrows on taut bows waiting for the licensing formality. On April 13, the morning after Mrs. Hobby licensed the vaccine, shipments went by air to Cutter’s branch offices in New York, Chicago, Dallas, and Los Angeles. When newspaper reporters attempted to find out how much had been shipped and where, Cutter and the others considered this an unwarranted invasion of company secrets. Commercial shipments of vaccine were not stopped until April 17 or thereabouts, but in these few days more than half the vaccine on hand entered commercial channels and thus was lost to the Polio Foundation’s program of free vaccinations for first and second graders.
The vaccine sold commercially was used for inoculations in total disregard of priorities for the age groups most vulnerable to infantile paralysis.
Manufacturers and drug merchants slipped the vaccine to their families, friends, and favorite customers, while doctors inoculated their families, friends, and favorite patients. A black market and super-profiteering arose.
Dr. Murray of the AMA urged parents not to rush to the doctor’s office ahead of their children and he suggested that public welfare and relief agencies purchase a supply of the vaccine for those unable to pay. All questions of “principle” are forever being reduced by the AMA to high fees coupled with charity work for “those unable to pay,” pious invocations and moral exhortations being all that is dispensed gratis.
On April 14 (two days after the licensing of the vaccine!) Eisenhower, away from Washington on one of his “work-and-play” jaunts, instructed Mrs. Hobby to draw up a strictly voluntary plan for distribution of the vaccine. Some Democrats such as Lister Hill of Georgia, chairman of the Senate Labor and Public Welfare Committee, at first agreed with Hobby and Eisenhower that the channeling of the vaccine to children and to the Polio Foundation should be strictly voluntary and not by compulsion. But public indignation became so strong that most Democrats began to call for federal control of distribution. Reuther and Meany joined the chorus, as did 37 out of 39 governors at a conference held in the beginning of May.
But the staunch free-enterprise gang in Washington stood pat on “voluntary” priorities, even while the various medical societies of New York made examples of a few doctors — unfortunate enough to get caught administering the vaccine to adults — by politely reprimanding them. Mrs. Hobby’s plan of distribution, presented back to Eisenhower on May 16, reiterated the strictly “voluntary” aspect of vaccine distribution plans.
The billionaires behind Eisenhower’s cabinet show no such reluctance nor do they rely on “voluntary” allocations when it comes to shortages of copper, tin, or aluminum. These “strategic” raw materials are stockpiled by the government at the current rate of one billion dollars a year to insure smooth-rolling profits for the barons of industry. Obviously, under “free enterprise,” vaccine to immunize children against the crippling ravages of polio is not a “strategic” raw material.
Even if it had been adopted, federal control of distribution could not have altered the succession of events that began on April 27 when the Cutter vaccine was banned. The polio vaccine drama had become a heartrending tragedy, striking deep into the feelings of anxious parents and into the nervous tissue of children and adults, paralyzing, maiming, killing. The world was stunned to discover that instead of providing immunity, the vaccine was spreading the disease.
On May 7, all vaccinations were ordered stopped, but the macabre total of polio infections continued to grow. As of June 17, cases of polio among vaccinated children stood at 146, of which 97 were paralytic cases. The break-down of cases per manufacturer is as follows: Cutter 72, Lilly 42, Parke-Davis 12, Wyeth 12, Pitman-Moore 4. There were also 81 cases among families of vaccinated children and 22 cases among other persons who came in contact with the children.
Exactly how many of these cases are due to defective vaccine and how many to natural infections can never be established. So far, the government has admitted finding live virus only in an unnamed number of batches by Cutter and in two by Wyeth. (In the case of Wyeth, the defective vaccine was caught in time.) In order to be appreciated in its true light, however, the American record must be compared to that of Canada.
Canada vaccinated half a million children, none of whom contracted polio after vaccination. Like the field trials of 1954 in the U.S., the Canadian experience with the Salk vaccine proves that a safe and effective vaccine can be produced and used. What the American debacle puts in question is not the safety of the vaccine but whether private enterprise can produce a safe and effective vaccine.
The Canadian government took over both production and distribution of the vaccine, initiating a vaccination program in which the provinces and the central government each paid half the cost. This program was drawn up in October 1954, long before the Francis report was made public. This, too, confirms the view that the sensation created by the Francis report was a publicity build-up and also gives the lie to Mrs. Hobby that “no one could have foreseen the public demand” for the vaccine. The Canadian government did foresee it, started the Cannaught Laboratories of the University of Toronto on production of the vaccine, and contracted for all of its output at cost.
The cost turned out to be $1.50 for three shots, the same three shots for which the Canadian government would have had to pay $4.33 if it bought it wholesale from American companies. We see then that the “margin of profit” obtained by the American drug companies is indeed quite “wide” — $2.83, or cost plus 189%.
The Canadian government kept the profit motive from entering into either the production or distribution of vaccine. Buying it at cost, the government distributes it free to the most vulnerable age groups on a strictly priority basis. The results are spectacular: No black market, no doctor’s fee, and no defective vaccine.
In Canada, national control of production and distribution was supplemented by exhaustive double-checking; once by the Cannaught Laboratories and then by the Federal Laboratory of Hygiene in Ottawa. This was in accordance with the practice during the 1954 field trials in the U.S. when each batch was triple-checked; first, by the laboratories of the manufacturing concerns; second, by Dr. Salk’s laboratories at the University of Pittsburgh; third, by the Federal Biologies Laboratory.
But then in the U.S. the precedent set in the 1954 field trials was not followed. Senator Morse was almost right in asserting that the U.S. government was more careful in its inspection of meat packing than it was of Salk vaccine production. Before May 7, the Federal Biologies Laboratory was only spot-checking batches of the vaccine. Thus in actuality the vaccine was being checked only once — by the manufacturer. Instead of making three, or at least two checks per batch, the government took the drug-makers at their word that everything was all right.
Each drug concern worked out its own particular manufacturing methods for the vaccine. As a result, no two processes were exactly alike. It was only after all vaccinations had been ordered stopped that government scientists began touring the plants to “study” the various processes. The government did not even know exactly how the vaccine was being made nor did it have a record of how many bad batches the manufacturers had thrown out.
The Democratic charges of bungling actually hide the real issue. It is a question of the holy fear of “creeping socialism” that animates the Eisenhower administration. Government intervention in private business is considered the deadliest of all sins. Dr. Scheele, United States Surgeon-General, for instance, fell all over himself in thanking the drug-makers for permitting government scientists to inspect the sacrosanct privacy of their plants and for being so unselfish as to pool each other’s production experience in making the vaccine.
The government sent squads of scientists “to appraise the facilities and procedures” of the drug-makers — not to test the batches, but to survey the productive methods. The release of each lot of vaccine was then highly publicized, with the inference that the reason for clearance was that the batch test reports and the plant appraisal program had established its safety. The inference was wrong. Parts of these batches had already been used to vaccinate hundreds of thousands of children. After an appropriate interval, when no trouble arose, the remainders of the batches were cleared !
On May 21, the inspection of drug concerns by the governmental flying squads was finished. On May 26, their findings and recommendations were reported. To locate the actual government findings, it is necessary to wade through a welter of mumbo-jumbo, through verbal dodges, feints and ducks, through pleasant words and mellow phrases, through declarations that the vaccine had always been safe and that it was merely being made-safer — safer than safe! — but in the end the actions proposed by the government proved a dead give away. As usual, it was not what was being said but what was being done that was important.
The government’s first proposal was reorganization of the manufacturing processes of the various vaccine producers. Cutter in particular would have to start from scratch. Secondly, the Federal Biologies Laboratory was reorganized and enlarged to a staff of 150 (almost five times its previous size). Moreover, a government inspector was to be stationed at each drug house.
These actions speak for themselves. They reveal the real issue; namely, that free enterprise cannot safely produce the polio vaccine — nor any other ticklish material where quality is paramount — without the strictest government intervention and supervision. The National Biologies Act of 1913 as well as the Food and Drug Act of 1937 were enacted precisely because profit-hungry capitalists cannot be trusted not to cut a corner here and there to save a few pennies in production or in transport, spoiling the product in the process.
That is why government inspectors during the war checked every rivet in airplanes, ships and tanks produced for military purposes; that is why there were almost as many government inspectors in the war plants as workers — but that of course was vital “war materiel” not such a trivial thing as polio vaccine for the nation’s children.
It is not that the drug-makers are a pack of scoundrels and rascals — we shall accept the assurances of O’Connor and the AMA that they are a bunch of high-minded, honest, American businessmen — the point is that when production takes place for profit then profits are the paramount consideration, not the quality or safety of the product. This was to be proved at once in real life, because all the vaccine-makers objected to the new procedures proposed by the government. On what grounds? That it would cost too much, that production (i.e., profits) would be slowed down. There is some indication that the final procedures adopted were some kind of compromise between the government and the manufacturers, what kind is not clear.
But the lesson to be drawn from the polio vaccine fiasco is clear enough: The Eisenhower “free-enterprise, laissez-faire” policy suffered shipwreck. By its actions, the government admitted that only under the strictest state supervision could “American businessmen” be saved from themselves and their own greed and be made to produce a safe vaccine.
The underlying issue of socialized medicine was raised not by the Democrats but by the Republicans when the Democrats in Congress proposed (not the elimination of the profit motive, or federal control of production and distribution) but merely that 130 million dollars be appropriated to provide free vaccine for all persons under 20. This, to the Republicans, was “creeping socialism”; the Eisenhower plan provides only 35 million dollars for needy children. The AMA, needless to say, does not like the Eisenhower proposal either, giving it only lukewarm assent as a sort of lesser evil. To the AMA, the Eisenhower plan too is “creeping socialism,” only it creeps a little slower than the Democratic proposal.
The Polio Foundation was able to develop a successful vaccine by the judicious application of a mere 22 million dollars for research and development, demonstrating what can be done with a few million dollars worth of medical research. However, the total annual income of all the foundations in this country is a mere 500 million dollars, only a small fraction (roughly one-fifth) of which is devoted to research.
If we look to the government to finance medical research, then we look in vain. The Hoover Commission reported that the annual federal expenditure for basic medical research in all fields amounts to 18 million dollars; that is, .0024% of the federal budget, or four million dollars less than it took to develop the Salk vaccine! The government spends more than a billion dollars a year on research to produce bigger and better H-bombs. Total military expenditures this year were listed at 32 billion dollars.
The Department of Agriculture is going to spend 10 million dollars more for investigating the prevention of plant and animal diseases than the U.S. Public Health Service is going to spend for research on cancer, arthritis, nervous and heart diseases all combined. Cows and oranges are more important in this country than people.
Even the stingy Hoover Commission had to admit that the situation smelled to high heaven. Medical schools in the United States are running an annual deficit of 15 million dollars. As a consequence, medical schools have had to restrict research and also the number of students. Thus, there were fewer medical school graduates in 1950 than there were in 1905. In proportion to the population, we have fewer doctors today than 100 years ago — in 1855!
If we turn to the medical profession as such for medical research, we can come only to the sad conclusion that, as presently organized in competitive private practice, it is simply not geared to prevent disease. The doctors are in business to cure disease after it has taken place. The medical profession, as we noted before, does not even have an efficient set-up for evaluating the new drugs offered them by the drug companies, much less some way of engaging in research either individually or as a group.
The American people are spending close to 10 billion dollars a year for medical services. This amount, at one and the same time, is too much and too little. It is too much because eight million families are in debt for medical care. It is too much because today illness is something that only the rich can afford. Among 90% of the American people, serious illness wipes out all savings, plunging families into economic distress from which it takes years to recover.
At the same time, 10.billion dollars a year for medical care is not enough. The AMA itself estimates that over a quarter of a million people die unnecessarily each year. With the present knowledge and skill of the medical profession, they could have been saved — IF (and this is the big “if”) sufficiently early diagnosis and treatment had been provided. Unfortunately, private competitive medicine and preventive medicine are mutually exclusive. To save 250,000 people a year from dying unnecessarily, it would be necessary to socialize medical practice.
Adlai Stephenson, speaking at the dedication of a new building at Bellevue Hospital in New York City on June 2, advanced the current Democratic Party program for reforming medical practice in this country. This program is quite ambitious; it conceives of nothing less than expanding voluntary, private, pre-payment health insurance. Even Stephenson, however, had to admit in the same breath that the coverage of such insurance plans is very rarely comprehensive and that only a very small percentage of medical costs is ever taken care of in this manner.
Medical insurance plans cover 75 million people today, a tremendous increase over the last few years — Stephenson thus is on safe grounds, advocating something that is taking place anyway. All these medical insurance plans together, however, paid only 8%, or 800 million dollars, of the total of 10 billion dollars spent by the American people for medical care.
Private health insurance plans have been found to cover the higher income groups rather than the lower, whites rather than Negroes, the North rather than the South, and the healthy rather than the sick. The insurance companies are no fools. They know what most doctors seem to have forgotten, that most diseases go hand in hand with poverty. Both the doctors and the insurance companies shy away from the poor. All that the expansion of commercial health insurance plans has done is to put another barrier in the path of reforming medical practice in the United States. The insurance companies fight shoulder to shoulder with the AMA and the drug concerns against the socialization of medicine.
Even from the purely medical point of view, competitive solo practice by individual doctors is as outmoded as medieval handicrafts. We have long passed the time when medical knowledge was so limited that one man could know all there was to know and one man could do all there was to do — when the doctor’s black bag held all the instruments and medicines he would likely need. A century ago, in the infancy of medical science, the personal element binding the patient to his beloved family doctor was perhaps the most important element in diagnosis and treatment, because so little was known about illness then.
Today the “sacred” personal relation between family doctor and patient (as the AMA is fond of calling it) is as outmoded as the intimate personal relation between the custom tailor and his client.
The family doctor is trained in observation and physical examination with his hands, stethoscope, and such aids, but today accurate diagnosis is made scientifically in a laboratory, from a few drops of blood, by a young man or woman who has never seen the patient. What difference then does it make whether the physician has his patient’s confidence, or whether he knows the whole family background and personal history of the patient, if a few injections of some chemical might be the cure? What good is the abdominal examination with the palpation and the percussion and the auscultation, when X-rays, lab tests of stomach contents, electrocardiograms, blood studies, urinalyses will tell the story sooner and more accurately?
Just as surely as hand tailoring and hand shoemaking had to give way to garment shops and shoe factories so the family doctor and the AMA are going to have to make way before the Clinics, the Out-patient Departments, before the teams of medical specialists working as groups supplied with all the latest scientific implements, and practicing preventive medicine.
All the advanced countries of the world, and some not so advanced, have reformed medical practice: Germany, France, England, Canada, Denmark, Holland, Belgium, Norway, Latin America, and others, all have some form of socialized medicine. The AMA and big business interests, in this country have bitterly fought this most elementary concession to the American working man and woman, who can afford family physicians as little as they can afford custom clothes or hand-made limousines.
The AMA has been dominated throughout the years by the older members of the medical profession — men who have achieved professional, financial, and social success and prominence. These doctors are settled in their ways, satisfied with life; outside their narrow and highly technical field, they think little and read less. They have put the American medical profession in the utterly ridiculous and untenable position where its leading organization has opposed any and all improvements of medical care ever suggested, planned, or put into effect. The AMA has fought cooperative clinics, group practice, state health boards, public health services, voluntary or compulsory health insurance.
There is a saying among American doctors that “you can get away with away with murder in surgery.” This refers both to the fees that surgeons command and to the fate of their patients. The saying applies to the American medical profession and to the system of competitive medicine as a whole. The polio vaccine scandal has proved once more that socialized medicine is one of the most pressing of all social reforms needed in the United States today.
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